Application of robot-assisted minimally invasive esophagectomy for patients with esophageal cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Hanlu , CHEN Longqi , GENG Yingcai , ZHENG Yu , WANG Zihao , WANG Fuqiang , LIN Yidan , HU Yang , YUAN Yong , WANG Wenping ,  WANG Yun

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

WANG Yun, Email: yunwwang@yeah.net

Keywords：

Esophageal neoplasms; da Vinci surgical system; robotic surgery

DOI：

10.7507/1007-4848.201806048

Video：

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Objective To present the initial clinical experience of robot-assisted thoracoscopic esophagectomy for patients with esophageal cancer and to analyze the short-term outcomes of these patients.Methods Between February 2016 and December 2017, 148 patients with esophageal carcinoma underwent robotic esophagectomy and two-fields lymph node dissection. There were 126 males and 22 females at average age of 62.0±8.0 years. Demographic data, intraoperative characteristics and short-term surgical outcomes were collected and analyzed.Results 106 patients underwent McKeown esophagectomy and 42 patients underwent Ivor-Lewis esophagectomy. The mean operation time was 336.0±76.0 min, the mean intraoperative blood loss was 130.0±89.0 ml, the mean number of lymph nodes removed was 21.0±8.0 and the mean length of postoperative hospital-stay was 12.0±7.2 days. Postoperative complications included anastomotic fistula (n=8, 5.4%), pulmonary infection (n=13, 8.7%), hoarseness (n=23, 15.5%), tracheoesophageal fistula (n=1, 0.7%), chylothorax (n=4, 2.7%) and incision infection (n=2, 1.4%). There was no intra-operational massive hemorrhage or in-hospital mortality.Conclusion Both robot-assisted McKeown and Ivor-Lewis esophagectomy are safe and feasible with good early outcomes.

Citation： ZHANG Hanlu, CHEN Longqi, GENG Yingcai, ZHENG Yu, WANG Zihao, WANG Fuqiang, LIN Yidan, HU Yang, YUAN Yong, WANG Wenping, WANG Yun. Application of robot-assisted minimally invasive esophagectomy for patients with esophageal cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(3): 206-210. doi: 10.7507/1007-4848.201806048 Copy

1.	Chen W, Zheng R, Zhang S, et al. Cancer incidence and mortality in China in 2013: an analysis based on urbanization level. Chin J Cancer Res, 2017, 29(1): 1-10.
2.	Ruurda JP, van der Sluis PC, van der Horst S, et al. Robot-assisted minimally invasive esophagectomy for esophageal cancer: A systematic review. J Surg Oncol, 2015, 112(3): 257-265.
3.	Guo W, Ma X, Yang S, et al. Combined thoracoscopic-laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes. Surg Endosc, 2016, 30(9): 3873-3881.
4.	van Hillegersberg R, Boone J, Draaisma WA, et al. First experience with robot-assisted thoracoscopic esophagolymphadenectomy for esophageal cancer. Surg Endosc, 2006, 20(9): 1435-1439.
5.	Xylinas E, Ploussard G, Durand X, et al. Robot-assisted extraperitoneal laparoscopic radical prostatectomy: a review of the current literature. Urol Oncol, 2013, 31(3): 288-293.
6.	Meredith K, Huston J, Andacoglu O, et al. Safety and feasibility of robotic-assisted Ivor-Lewis esophagectomy. Dis Esophagus, 2018, 31(7).
7.	Park SY, Kim DJ, Yu WS, et al. Robot-assisted thoracoscopic esophagectomy with extensive mediastinal lymphadenectomy: experience with 114 consecutive patients with intrathoracic esophageal cancer. Dis Esophagus, 2016, 29(4): 326-332.
8.	张晓彬, 杨煜, 叶波, 等. 机器人辅助食管癌根治术的近期手术结果. 中国医师杂志, 2017, (7): 970-973.
9.	van der Sluis PC, Ruurda JP, Verhage RJ, et al. Oncologic long-term results of robot-assisted minimally invasive thoraco-laparoscopic esophagectomy with two-field lymphadenectomy for esophageal cancer. Ann Surg Oncol, 2015, 22(Suppl 3): S1350-S1356.
10.	Zhang H, Chen L, Wang Z, et al. The learning curve for robotic mckeown esophagectomy in patients with esophageal cancer. Ann Thorac Surg, 2018, 105(4): 1024-1030.
11.	Gao Y, Wang Y, Chen L, et al. Comparison of open three-field and minimally-invasive esophagectomy for esophageal cancer. Interact Cardiovasc Thorac Surg, 2011, 12(3): 366-369.
12.	Zheng Y, Zhao XW, Zhang HL, et al. Modified exposure method for gastric mobilization in robot-assisted esophagectomy. J Thorac Dis, 2017, 9(12): 4960-4966.
13.	Zhu ZJ, Zhao YF, Chen LQ, et al. Clinical application of layered anastomosis during esophagogastrostomy. World J Surg, 2008, 32(4): 583-588.
14.	Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256(1): 95-103.
15.	Verhage RJ, Hazebroek EJ, Boone J, et al. Minimally invasive surgery compared to open procedures in esophagectomy for cancer: a systematic review of the literature. Minerva Chir, 2009, 64(2): 135-146.
16.	Cadiere GB, Himpens J, Vertruyen M, et al. The world's first obesity surgery performed by a surgeon at a distance. Obes Surg, 1999, 9(2): 206-209.
17.	Melvin WS, Needleman BJ, Krause KR, et al. Computer-enhanced robotic telesurgery. Initial experience in foregut surgery. Surg Endosc, 2002, 16(12): 1790-1792.
18.	Park S, Hwang Y, Lee HJ, et al. Comparison of robot-assisted esophagectomy and thoracoscopic esophagectomy in esophageal squamous cell carcinoma. J Thorac Dis, 2016, 8(10): 2853-2861.
19.	Abbott A, Shridhar R, Hoffe S, et al. Robotic assisted Ivor Lewis esophagectomy in the elderly patient. J Gastrointest Oncol, 2015, 6(1): 31-38.
20.	Dantoc MM, Cox MR, Eslick GD. Does minimally invasive esophagectomy (MIE) provide for comparable oncologic outcomes to open techniques? A systematic review. J Gastrointest Surg, 2012, 16(3): 486-494.
21.	徐志华, 张含露, 杨梅, 等. 达芬奇机器人与胸腹腔镜联合辅助McKeown食管癌根治术后患者短期疼痛的非随机对照研究. 中国胸心血管外科临床杂志, 2018, 25(5): 378-381.

1. Chen W, Zheng R, Zhang S, et al. Cancer incidence and mortality in China in 2013: an analysis based on urbanization level. Chin J Cancer Res, 2017, 29(1): 1-10.
2. Ruurda JP, van der Sluis PC, van der Horst S, et al. Robot-assisted minimally invasive esophagectomy for esophageal cancer: A systematic review. J Surg Oncol, 2015, 112(3): 257-265.
3. Guo W, Ma X, Yang S, et al. Combined thoracoscopic-laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes. Surg Endosc, 2016, 30(9): 3873-3881.
4. van Hillegersberg R, Boone J, Draaisma WA, et al. First experience with robot-assisted thoracoscopic esophagolymphadenectomy for esophageal cancer. Surg Endosc, 2006, 20(9): 1435-1439.
5. Xylinas E, Ploussard G, Durand X, et al. Robot-assisted extraperitoneal laparoscopic radical prostatectomy: a review of the current literature. Urol Oncol, 2013, 31(3): 288-293.
6. Meredith K, Huston J, Andacoglu O, et al. Safety and feasibility of robotic-assisted Ivor-Lewis esophagectomy. Dis Esophagus, 2018, 31(7).
7. Park SY, Kim DJ, Yu WS, et al. Robot-assisted thoracoscopic esophagectomy with extensive mediastinal lymphadenectomy: experience with 114 consecutive patients with intrathoracic esophageal cancer. Dis Esophagus, 2016, 29(4): 326-332.
8. 张晓彬, 杨煜, 叶波, 等. 机器人辅助食管癌根治术的近期手术结果. 中国医师杂志, 2017, (7): 970-973.
9. van der Sluis PC, Ruurda JP, Verhage RJ, et al. Oncologic long-term results of robot-assisted minimally invasive thoraco-laparoscopic esophagectomy with two-field lymphadenectomy for esophageal cancer. Ann Surg Oncol, 2015, 22(Suppl 3): S1350-S1356.
10. Zhang H, Chen L, Wang Z, et al. The learning curve for robotic mckeown esophagectomy in patients with esophageal cancer. Ann Thorac Surg, 2018, 105(4): 1024-1030.
11. Gao Y, Wang Y, Chen L, et al. Comparison of open three-field and minimally-invasive esophagectomy for esophageal cancer. Interact Cardiovasc Thorac Surg, 2011, 12(3): 366-369.
12. Zheng Y, Zhao XW, Zhang HL, et al. Modified exposure method for gastric mobilization in robot-assisted esophagectomy. J Thorac Dis, 2017, 9(12): 4960-4966.
13. Zhu ZJ, Zhao YF, Chen LQ, et al. Clinical application of layered anastomosis during esophagogastrostomy. World J Surg, 2008, 32(4): 583-588.
14. Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256(1): 95-103.
15. Verhage RJ, Hazebroek EJ, Boone J, et al. Minimally invasive surgery compared to open procedures in esophagectomy for cancer: a systematic review of the literature. Minerva Chir, 2009, 64(2): 135-146.
16. Cadiere GB, Himpens J, Vertruyen M, et al. The world's first obesity surgery performed by a surgeon at a distance. Obes Surg, 1999, 9(2): 206-209.
17. Melvin WS, Needleman BJ, Krause KR, et al. Computer-enhanced robotic telesurgery. Initial experience in foregut surgery. Surg Endosc, 2002, 16(12): 1790-1792.
18. Park S, Hwang Y, Lee HJ, et al. Comparison of robot-assisted esophagectomy and thoracoscopic esophagectomy in esophageal squamous cell carcinoma. J Thorac Dis, 2016, 8(10): 2853-2861.
19. Abbott A, Shridhar R, Hoffe S, et al. Robotic assisted Ivor Lewis esophagectomy in the elderly patient. J Gastrointest Oncol, 2015, 6(1): 31-38.
20. Dantoc MM, Cox MR, Eslick GD. Does minimally invasive esophagectomy (MIE) provide for comparable oncologic outcomes to open techniques? A systematic review. J Gastrointest Surg, 2012, 16(3): 486-494.
21. 徐志华, 张含露, 杨梅, 等. 达芬奇机器人与胸腹腔镜联合辅助McKeown食管癌根治术后患者短期疼痛的非随机对照研究. 中国胸心血管外科临床杂志, 2018, 25(5): 378-381.

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